Intestinal Pseudo-Obstruction (Ogilvie Syndrome)

Abstract

Intestinal pseudo-obstruction or Ogilvie syndrome is thought to be caused by imbalance of the autonomic nervous system, specifically decreased parasympathetic activity. It usually affects elderly patients with a slight male predominance. It is also associated with trauma, burns, recent surgery, and various anticholinergic medications (opioids and clozapine). Patients usually present with abdominal distention, nausea, and vomiting as well as constipation. Ogilvie syndrome has a high mortality rate related to complications like ischemic bowel perforation, stressing the importance of a timely diagnosis.

What is Ogilvie syndrome ?	Acute colonic distention without an underlying mechanical obstruction [1]
What is the cause of Ogilvie syndrome?	Decrease in parasympathetic activity which usually increases gut motility [1]
What are some etiologies of colonic pseudo-obstruction?	Inflammatory (abscess, appendicitis), traumatic, urologic (renal tumor ablation, calculi), obstetric (normal pregnancy), all systemic infections, metabolic, oncologic, and medications (narcotics, anticholinergics)
What are some common radiographic findings?	Colonic distention predominantly involving the cecum, ascending colon, and transverse colon [1]
What is the major concern with Ogilvie syndrome?	Cecal ischemia and perforation (risk 3–15%) [2]
How are LBO and Ogilvie syndrome distinguished on radiographs?	Right lateral decubitus or prone images obtained a few minutes after initial supine images show air filling the distal colon in Ogilvie syndrome.
How are paralytic ileus and Ogilvie syndrome differentiated?	An intermediate transitional zone at or adjacent to the splenic flexure is only present in Ogilvie syndrome [2].
What is the treatment of Ogilvie syndrome?	Neostigmine (parasympathetic stimulation) or lower endoscopic decompression